Why we should take seriously the differences between “pee-pee” and “urine”

10 Minutes to Better Patient Communication

No, really. There are important differences between the terms “pee-pee” and “urine.” Here’s what they are, and why anyone who cares about patient communication and education should take these differences seriously.

EPISODE TRANSCRIPT

Aww shucks. It's happened. I got COVID. And the timing! Last episode we made our big announcement, our new course platform and our new video based communication course for all patient facing employees. It's been years in the making you've seen me during the years building this! You've been a part of building it! So let's take a moment to appreciate what we've been doing together, and take a close look at the work that words do in health. Like the difference between “pee-pee” and “urine.”

Hi everybody, this is 10 Minutes to Better Patient Communication from Health Communication Partners. I'm Dr. Anne Marie Liebel. We have a brand new video based course, Foundations of Equitable Interpersonal Communication in Health. It is for all patient-facing employees. Medical staff, hospital staff, community health workers and more. It helps organizations address health inequalities because it's about cultural mismatches in communication that can contribute to miscommunication. And it is available right now on HealthCommunicationPartners.com!

I want to thank everyone for their really enthusiastic response to our big announcements. if you haven't seen the video about our new course I'll put the link in the notes. And because life is hilarious, right after all this, the big reveal, all the excitement, the culmination of years of work and research, I get COVID. Now I'm vaxxed and boosted so I'm able to ride it out at home with cold medicine and lots of tea. But to spare you having to listen to me sound like this for 10 minutes, I'm going back to a favorite early episode, that, like all of them, starts with a question or problem faced by a health professional. During a series of talks I was giving at the Medical College of Georgia, a Nurse Educator shared a story, and a hard-hitting question. Here it is.

I was talking with a Nurse Educator about the uncertainty and difficulties nursing students can face, as they learn the specialized language of medicine. She said,

Because this is a different language. It's very difficult for a student to come in and talk urination.' They're used to saying pee.' And yet their patients aren't going to say, I urinated today.' They're going to say I peed today.' [So students wonder] how do I talk to you, how do I talk to you?

One of the biggest trip hazards in health communication is the specialized language used in medicine. Medical information, terminology, and forms can be intimidating for anyone who doesn't deal with them regularly.

By now you know the benefits of clear and timely patient-centered communication.

As if the clear' part wasn't tough enough, you usually are communicating under serious time constraints.

This podcast is to help you start to become aware of your own language and your patients' so you can make some progress on that question: How do I talk to you?

We all use language every day in complex ways. We are often unaware of the sophisticated uses of language in our everyday lives, as they are habitual or unconscious. So let's stop for a moment and think about some things we tend to take for granted when we speak.

The groups we're a part of have an enormous impact on the words we use. They shape what counts for us as normal or common language. The way our words have been used by people in the past and by whom influences how we use them in the present.

Think of language as something in our human tool kit. It's one of our most powerful tools, and we're always using it to make things happen. We make our words do work.

The nurse educator and I continued to talk about the shift in the work, and the thinking, and the context involved in the shift in language from pee' to urine.'

She added that there's another, potentially earlier, step here, isn’t there? She pointed out that parents may teach children the term pee-pee' in the context of potty training.'

Let's think about pee-pee for a moment.

In a language sense, pee-pee does specific work. It gives a label to a body function that, for the child, has been unnamed until now.

But now, this body function needs a name! Because it's an important topic in the household!

So the child transitions from diapers to toilet use, through learning to be aware of and monitoring this body function. And that monitoring, that awareness, is supported by talk. Namely, everyone's very pointed use of the term pee-pee.

The word does its job. The child is potty trained.

Eventually, though, the word pee-pee outlives its usefulness, as the child learns, maybe when they're in school, that big kids don't say pee-pee. When it ceases to be useful for the child, it's dropped in favor of the grownup version, pee.

Like pee-pee, pee works just fine. Unless you go into medicine.

It's not that there's anything wrong with the word pee. And it's not that non-medical professionals couldn't understand the word urinate. It's more that we will use a term that does the work we need it to do, until we have a good reason for changing it.

The Discourse of Medicine was published about 30 years ago, and it underlined the significance of the ways people use language in health-related interactions. The author Eliot Mishler says:

The point of departure for this research is to treat medical interviews as a form of discourse, that is, as meaningful talk between patients and physicians. Further, this discourse is viewed seriously; it is not mere' talk, but the work that doctor and patient do together as an essential and critical component of clinical practice.

We all have been socialized into various ways of thinking about and talking about health, well-being, and health care. It can be easy to take for granted that the people around us share our linguistic and cultural practices. In health care, the people you work with use the same kinds of language you use, for the same reasons you use it (more or less).

So when it comes to your patients and their families, it can seem natural to compare their ways of talking, thinking about, and doing health with yours. Or maybe with your idea of the average' or mainstream' patient.

Don't let that difference become an obstacle in your relationship. Their words work for them in the context of their lives, just as surely as yours do for you.

Sure, pee-pee, pee, and urine are different terms for the same thing, at least on a surface level. But they do different work. They are used for different reasons, for which they are entirely adequate. One is not better than the other.

I want to return to what the nurse educator said when talking about her students’ concerns: how do I talk to you? how do I talk to you?

Here are three things to remember, and some phrases you might consider, in your next patient encounter:

1. Your patient's language

Approach your patient as someone who uses language in sophisticated ways in their everyday life. Speak to them with this assumption in mind. An important approach in patient communication is connecting the health information you hold, to what the community you are trying to reach already values. And that includes the language they already use.

2. Your language

In whatever wording feels natural to you, mention that you're aware medicine has some of the most unusual language out there, and that it took you years to learn it. Now, you're surrounded all day by people whose jobs require this specialized language use. This can be a drawback in conversations with people whose jobs don't depend on speaking this same language. But you're doing your best to be aware of when you're using insider terms.

3. The work you're doing together

Looking at patients' knowledge and language use as a gap' between you, can imply that your position is the one to be reached. In this view, progress counts as how far patients can make it in your direction.

Mention that, as you talk together, you the practitioner are drawing on all your medical experience and education, and they the patient are drawing on a lifetime of experience with their body. You both have your areas of expertise. Assure them these are complementary and not competing knowledge bases. Because both of them are necessary for this to work.

The benefits to paying attention to your language are that you can make adjustments. So that you can speak in a way patients will understand. Build those bridges, you've heard me say that before. The benefits of paying attention to your patients' language includes learning what matters to them, and therefore, where you can start to build the bridge between you.

I'm Dr. Anne Marie Liebel. This has been “10 Minutes To Better Patient Communication.”

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